PN 140 Test 4 Practice Questions and
answers
A client who has been diagnosed with calculi reports that the pain is intermittent and less colicky. Which
of the following nursing actions is most important at this time?
A. Report hematuria to the physician
B. Strain the urine carefully
C. Administer meperidine (Demerol) every 3 hours
D. Apply warm compresses to the flank area -Correct Answer-B. Strain the urine carefully
Intermittent pain that is less colicky indicates that the calculi may be moving along the urinary tract.
Fluids should be encouraged to promote movement, and the urine should be strained to detect passage
of the stone. Hematuria is to be expected from the irritation of the stone. Analgesics should be
administered when the client needs them, not routinely. Moist heat to the flank area is helpful when
renal colic occurs, but it is less necessary as pain is lessened.
A client is admitted to the hospital with a diagnosis of renal calculi. The client is experiencing severe flank
pain and nausea; the temperature is 100.6 ° F (38.1 ° C). Which of the following would be a priority
outcome for this client?
1. Prevention of urinary tract complications.
2. Alleviation of nausea.
3. Alleviation of pain.
4. Maintenance of fluid and electrolyte balance. -Correct Answer-3.
The priority nursing goal for this client is to alleviate the pain, which can be excruciating. Prevention of
urinary tract complications and alleviation of nausea are appropriate throughout the client's
hospitalization, but relief of the severe pain is a priority. The client is at little risk for fluid and electrolyte
imbalance.
The client is scheduled to have a kidney, ureter, and bladder (KUB) radiograph. To prepare the client for
this procedure, the nurse should explain to the client that:
,1. Fluid and food will be withheld the morning of the examination.
2. A tranquilizer will be given before the examination.
3. An enema will be given before the examination.
4. No special preparation is required for the examination. -Correct Answer-4.
A KUB radiographic examination ordinarily requires no preparation. It is usually done while the client lies
supine and does not involve the use of radiopaque substances.
In addition to nausea and severe flank pain, a female client with renal calculi has pain in the groin and
bladder. The nurse should assess the client further for signs of:
1. Nephritis.
2. Referred pain.
3. Urine retention.
4. Additional stone formation. -Correct Answer-2.
The pain associated with renal colic due to calculi is commonly referred to the groin and bladder in
female clients and to the testicles in male clients. Nausea, vomiting, abdominal cramping, and diarrhea
may also be present. Nephritis or urine retention is an unlikely cause of the referred pain. The type of
pain described in this situation is unlikely to be caused by additional stone formation.
Which of the following nursing interventions is likely to provide the most relief from the pain associated
with renal colic?
1. Applying moist heat to the flank area.
2. Administering meperidine (Demerol).
3. Encouraging high fluid intake.
4. Maintaining complete bed rest. -Correct Answer-2.
,During episodes of renal colic, the pain is excruciating. It is necessary to administer opioid analgesics to
control the pain. Application of heat, encouraging high fluid intake, and limitation of activity are
important interventions, but they will not relieve the renal colic pain.
A client with a history of renal calculi formation is being discharged after surgery to remove the calculus.
What instructions should the nurse include in the client's discharge teaching plan?
1. Increase daily fluid intake to at least 2 to 3 L.
2. Strain urine at home regularly.
3. Eliminate dairy products from the diet.
4. Follow measures to alkalinize the urine. -Correct Answer-1.
A high daily fluid intake is essential for all clients who are at risk for calculi formation because it prevents
urinary stasis and concentration, which can cause crystallization. Depending on the composition of the
stone, the client also may be instructed to institute specific dietary measures aimed at preventing stone
formation. Clients may need to limit purine, calcium, or oxalate. Urine may need to be either alkaline or
acid. There is no need to strain urine regularly.
During hemodialysis, the patient develops light-headedness and nausea. What should the nurse do first?
a. Administer hypertonic saline.
b. Administer a blood transfusion.
c. Decrease the rate of fluid removal.
d. Administer antiemetic medications. -Correct Answer-c. Decrease the rate of fluid removal.
The patient is experiencing hypotension from a rapid removal of vascular volume. The rate and volume
of fluid removal will be decreased, and 0.9% saline solution may be infused. Hypertonic saline is not used
because of the high sodium load. A blood transfusion is not indicated. Antiemetic medications may help
the nausea but would not help the hypovolemia.
The patient has rapidly progressing glomerular inflammation. Weight has increased and urine output is
steadily declining. What is the priority nursing intervention?
, a. Monitor the patient's cardiac status.
b. Teach the patient about hand washing.
c. Obtain a serum specimen for electrolytes.
d. Increase direct observation of the patient. -Correct Answer-a. Monitor the patient's cardiac status.
The nurse's priority is to monitor the patient's cardiac status. With the rapidly progressing
glomerulonephritis, renal function begins to fail and fluid, potassium, and hydrogen retention lead to
hypervolemia, hyperkalemia, and metabolic acidosis. Excess fluid increases the workload of the heart,
and hyperkalemia can lead to life-threatening dysrhythmias. Teaching about hand washing and
observation of the patient are important nursing interventions but are not the priority. Electrolyte
measurement is a collaborative intervention that will be done as ordered by the health care provider.
A 78-yr-old patient has stage 3 CKD and is being taught about a low-potassium diet. The nurse knows the
patient understands the diet when the patient selects which foods to eat?
a. Apple, green beans, and a roast beef sandwich
b. Granola made with dried fruits, nuts, and seeds
c. Watermelon and ice cream with chocolate sauce
d. Bran cereal with ½ banana and milk and orange juice -Correct Answer-a. Apple, green beans, and a
roast beef sandwich
When the patient selects an apple, green beans, and a roast beef sandwich, the patient demonstrates
understanding of the low-potassium diet. Granola, dried fruits, nuts and seeds, milk products, chocolate
sauce, bran cereal, banana, and orange juice all have elevated levels of potassium, at or above 200 mg
per 1/2 cup.
Which assessment findings would alert the nurse that the patient has entered the diuretic phase of
acute kidney injury (AKI)?
Select all that apply.
a. Dehydration
b. Hypokalemia
c. Hypernatremia
